Secreted from the adrenal glands, cortisol is a glucocorticoid commonly referred to as a steroid hormone. Every human being has two adrenal glands sitting on each kidney and is responsible for the secretion of cortisol. High cortisol levels increases pain sensitivity.
Cortisol is a potent anti-inflammatory that functions to mobilize glucose reserves for energy and modulate inflammation. Cortisol also may facilitate the consolidation of fear-based memories for future survival and avoidance of danger. Although short-term stress may be adaptive, maladaptive responses (eg, magnification, rumination, helplessness) to pain or non-pain-related stressors may intensify cortisol secretion and condition a sensitized physiologic stress response that is readily recruited. Ultimately, a prolonged or exaggerated stress response may perpetuate cortisol dysfunction, widespread inflammation, and pain. (Hannibal &Bishop, 2014)
Low cortisol and greater psychological stress, which are also associated with minority status and single individuals, contribute to chronic pain in the traumatically injured population. Trauma victims without an adequate cortisol response to acute injury and pain are at risk for development of chronic pain after injury. (Trevino et al, 2021)
Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther. 2014 Dec;94(12):1816-25. doi: 10.2522/ptj.20130597. Epub 2014 Jul 17. PMID: 25035267; PMCID: PMC4263906.
Trevino CM, Geier T, Morris R, Cronn S, deRoon-Cassini T. Relationship Between Decreased Cortisol and Development of Chronic Pain in Traumatically Injured. J Surg Res. 2022 Feb;270:286-292. doi: 10.1016/j.jss.2021.08.040. Epub 2021 Oct 28. PMID: 34717262; PMCID: PMC8712402.